Nov 5, 2019
Because diabetes is a primary risk factor for PAD, patient education and screening of at-risk populations is critical to reducing lower limb amputations
WASHINGTON – In recognition of American Diabetes Month, which starts on November 1, the Cardiovascular Coalition (CVC), a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD), encourages Americans living with diabetes and pre-diabetes to learn more about their risks for PAD.
More than 30 million Americans with diabetes and an additional 84.1 million Americans with prediabetes are at an elevated risk of developing PAD, which causes severe leg pain and often leads to multiple complications including gangrene, diabetic foot ulcers, and amputation if left untreated. PAD, which causes an estimated 85 percent of the 200,000 non-traumatic limb amputations in the U.S. each year, disproportionally impacts minority populations. It is caused by a build-up of fatty deposits in a person’s arteries over time and because high blood glucose can damage blood vessels, diabetes is considered a primary risk factor for PAD.
Early PAD screening among at-risk populations has been shown to reduce the probability of an amputation resulting from PAD by 90 percent, but is greatly underutilized as only 12.5 percent of PAD cases are identified by doctors and treated. Overall, many of the non-traumatic amputations that occur in the United States each year could be avoided with the proper clinical intervention and treatment.
Unfortunately, screening for PAD is still not commonplace, even amongst at-risk patients. Despite the clear risks, the U.S. Preventative Services Task Force (USPSTF) released guidelines that conclude “the current evidence is insufficient to assess the balance of benefits and harms of screening for peripheral artery disease and cardiovascular disease risk with the ankle-brachial index (ABI) in asymptomatic adults.” Unfortunately, by making recommendations for the general public—as opposed to at-risk individuals and communities— the USPSTF’s guidelines do a disservice to at-risk patients.
Instead, the American College of Cardiology and American Heart Association joint practice guidelines recommend PAD screening for high-risk patients.
Lawmakers in Congress are also drawing attention to the importance of understanding PAD. Earlier this year, bipartisan lawmakers in the U.S. House of Representatives launched a Congressional PAD Caucus to educate Congress and communities about PAD while supporting legislative activities to improve PAD research, education, and treatment, with the goal of preventing non-traumatic amputations due to PAD and other related diseases. As part of their policy agenda to support our goal of preventing amputations, the caucus is urging the USPSTF to review screening for PAD for at-risk patients.
“In recognition of American Diabetes Month, Americans with diabetes and prediabetes are encouraged to talk to their doctor about their risks for PAD, which can help them avoid dangerous complications including amputation,” said Dr. Jeffrey Carr, MD, FACC, founding and immediate past president of the Outpatient Endovascular and Interventional Society and a member of the CVC . “We look forward to working with lawmakers in the Congressional PAD Caucus to advance policies that ensure patient access to clinically appropriate PAD care to prevent limb loss, improve lives, and reduce healthcare costs.”